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Pfledderer CD, von Klinggraeff L, Burkart S, da Silva Bandeira A, Lubans DR, Jago R, Okely AD, van Sluijs EMF, Ioannidis JPA, Thrasher JF, Li X, Beets MW. Consolidated guidance for behavioral intervention pilot and feasibility studies. Pilot Feasibility Stud 2024; 10:57. [PMID: 38582840 PMCID: PMC10998328 DOI: 10.1186/s40814-024-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/26/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND In the behavioral sciences, conducting pilot and/or feasibility studies (PFS) is a key step that provides essential information used to inform the design, conduct, and implementation of a larger-scale trial. There are more than 160 published guidelines, reporting checklists, frameworks, and recommendations related to PFS. All of these publications offer some form of guidance on PFS, but many focus on one or a few topics. This makes it difficult for researchers wanting to gain a broader understanding of all the relevant and important aspects of PFS and requires them to seek out multiple sources of information, which increases the risk of missing key considerations to incorporate into their PFS. The purpose of this study was to develop a consolidated set of considerations for the design, conduct, implementation, and reporting of PFS for interventions conducted in the behavioral sciences. METHODS To develop this consolidation, we undertook a review of the published guidance on PFS in combination with expert consensus (via a Delphi study) from the authors who wrote such guidance to inform the identified considerations. A total of 161 PFS-related guidelines, checklists, frameworks, and recommendations were identified via a review of recently published behavioral intervention PFS and backward/forward citation tracking of a well-known PFS literature (e.g., CONSORT Ext. for PFS). Authors of all 161 PFS publications were invited to complete a three-round Delphi survey, which was used to guide the creation of a consolidated list of considerations to guide the design, conduct, and reporting of PFS conducted by researchers in the behavioral sciences. RESULTS A total of 496 authors were invited to take part in the three-round Delphi survey (round 1, N = 46; round 2, N = 24; round 3, N = 22). A set of twenty considerations, broadly categorized into six themes (intervention design, study design, conduct of trial, implementation of intervention, statistical analysis, and reporting) were generated from a review of the 161 PFS-related publications as well as a synthesis of feedback from the three-round Delphi process. These 20 considerations are presented alongside a supporting narrative for each consideration as well as a crosswalk of all 161 publications aligned with each consideration for further reading. CONCLUSION We leveraged expert opinion from researchers who have published PFS-related guidelines, checklists, frameworks, and recommendations on a wide range of topics and distilled this knowledge into a valuable and universal resource for researchers conducting PFS. Researchers may use these considerations alongside the previously published literature to guide decisions about all aspects of PFS, with the hope of creating and disseminating interventions with broad public health impact.
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Affiliation(s)
- Christopher D Pfledderer
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, 78701, USA.
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, 78701, USA.
| | | | - Sarah Burkart
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | | | - David R Lubans
- College of Human and Social Futures, The University of Newcastle Australia, Callaghan, NSW, 2308, Australia
| | - Russell Jago
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 1QU, UK
| | - Anthony D Okely
- Faculty of Arts, Social Sciences and Humanities, School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
| | | | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
- Department of Statistics, Stanford University, Stanford, CA, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | - Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
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Naylor JM, Gibson K, Mills K, Schabrun SM, Livings R, Dennis S, Thom J. A snapshot of primary care physiotherapy management of knee osteoarthritis in an Australian setting: does it align with evidence-based guidelines? Physiother Theory Pract 2024; 40:347-356. [PMID: 36036385 DOI: 10.1080/09593985.2022.2114816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/06/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Systematic implementation of evidence-based, clinical practice guidelines for management of knee osteoarthritis (OA) in primary care physiotherapy in Australia is embryonic. Clinical practice guidelines have been implemented in the public healthcare sector at a State-level for physiotherapists in the form of multidisciplinary programs, but the reach of physiotherapy-led OA management programs is grossly inadequate in the private sector. OBJECTIVE To provide a snapshot of the management of people with knee OA in private physiotherapy practice in an Australian setting. Primarily the aim was to determine the alignment between the treatment provided and guideline-based management. Secondary aims included the capture of both patient-reported improvement after 3-months and patient satisfaction with treatment. Whether patient-reported outcome measures (PROMS) were routinely used was also ascertained. METHODS A prospective, observational study enrolling adults >=45 years with knee OA across nine primary care physiotherapy practices. Knee injury OA Outcome Score (KOOS) and Routine Assessment Patient Index 3 (RAPID3) were collected (baseline; 3 months) by researchers along with satisfaction with treatment. Treatment details and use of PROMS were obtained from physiotherapy record audit and patient interview. The treatment provided was compared to the minimum core elements of management stipulated in OA management guidelines. RESULTS Twenty-six adults (58% female, mean age 60 (9) years, 54% overweight or obese) participated. 100% were prescribed ≥1 appropriate exercise(s); 42% received OA education; 12% received weight management advice. Mean improvement (95%CI) in KOOS Pain was 9.8 (3.4 to 16.1) and RAPID3 was -3.4 (-5.5 to -1.3). Satisfaction with treatment was high (8.3/10). No PROMs were used for assessment or monitoring. CONCLUSION Primary care physiotherapy treatment of knee OA did not meet minimum criteria per clinical practice guidelines. However, participant improvement at three months reached minimally important change thresholds for patient-reported measures and satisfaction was high. The data provide useful insights about areas that are deficient, thus, should inform future implementation strategies designed to improve care delivery and the uptake of routine measurement of patient-reported outcomes.
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Affiliation(s)
- Justine M Naylor
- Orthopaedic Department, Liverpool Hospital, Liverpool, Australia
| | - Kathryn Gibson
- Orthopaedic Department, Liverpool Hospital, Liverpool, Australia
| | - Kat Mills
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Siobhan M Schabrun
- Gray Center for Mobility and Activity, Parkwood Institute, London, ON, Canada
- School of Physical Therapy, University of Western Ontario, London, ON, Canada
- Centre for Pain, Neuroscience Research Australia, Randwick, Australia
| | - Rebecca Livings
- Centre for Pain, Neuroscience Research Australia, Randwick, Australia
| | - Sarah Dennis
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Allied Health, Injury and Rehabilitation Stream, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Jeanette Thom
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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Pfledderer CD, von Klinggraeff L, Burkart S, da Silva Bandeira A, Lubans DR, Jago R, Okely AD, van Sluijs EM, Ioannidis JP, Thrasher JF, Li X, Beets MW. Expert Perspectives on Pilot and Feasibility Studies: A Delphi Study and Consolidation of Considerations for Behavioral Interventions. RESEARCH SQUARE 2023:rs.3.rs-3370077. [PMID: 38168263 PMCID: PMC10760234 DOI: 10.21203/rs.3.rs-3370077/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background In the behavioral sciences, conducting pilot and/or feasibility studies (PFS) is a key step that provides essential information used to inform the design, conduct, and implementation of a larger-scale trial. There are more than 160 published guidelines, reporting checklists, frameworks, and recommendations related to PFS. All of these publications offer some form of guidance on PFS, but many focus on one or a few topics. This makes it difficult for researchers wanting to gain a broader understanding of all the relevant and important aspects of PFS and requires them to seek out multiple sources of information, which increases the risk of missing key considerations to incorporate into their PFS. The purpose of this study was to develop a consolidated set of considerations for the design, conduct, implementation, and reporting of PFS for interventions conducted in the behavioral sciences. Methods To develop this consolidation, we undertook a review of the published guidance on PFS in combination with expert consensus (via a Delphi study) from the authors who wrote such guidance to inform the identified considerations. A total of 161 PFS-related guidelines, checklists, frameworks, and recommendations were identified via a review of recently published behavioral intervention PFS and backward/forward citation tracking of well-know PFS literature (e.g., CONSORT Ext. for PFS). Authors of all 161 PFS publications were invited to complete a three-round Delphi survey, which was used to guide the creation of a consolidated list of considerations to guide the design, conduct, and reporting of PFS conducted by researchers in the behavioral sciences. Results A total of 496 authors were invited to take part in the Delphi survey, 50 (10.1%) of which completed all three rounds, representing 60 (37.3%) of the 161 identified PFS-related guidelines, checklists, frameworks, and recommendations. A set of twenty considerations, broadly categorized into six themes (Intervention Design, Study Design, Conduct of Trial, Implementation of Intervention, Statistical Analysis and Reporting) were generated from a review of the 161 PFS-related publications as well as a synthesis of feedback from the three-round Delphi process. These 20 considerations are presented alongside a supporting narrative for each consideration as well as a crosswalk of all 161 publications aligned with each consideration for further reading. Conclusion We leveraged expert opinion from researchers who have published PFS-related guidelines, checklists, frameworks, and recommendations on a wide range of topics and distilled this knowledge into a valuable and universal resource for researchers conducting PFS. Researchers may use these considerations alongside the previously published literature to guide decisions about all aspects of PFS, with the hope of creating and disseminating interventions with broad public health impact.
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Affiliation(s)
| | | | - Sarah Burkart
- University of South Carolina Arnold School of Public Health
| | | | | | - Russ Jago
- University of Bristol Population Health Sciences
| | | | | | | | | | - Xiaoming Li
- University of South Carolina Arnold School of Public Health
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Thom JM, Dennis S, Gibson KA, Livings R, Mills K, Schabrun SM, Sun H, Naylor JM. Knee osteoarthritis patient perspectives of their care in an australian private physiotherapy setting: a qualitative exploratory interview study. BMC Musculoskelet Disord 2023; 24:564. [PMID: 37434180 DOI: 10.1186/s12891-023-06692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/04/2023] [Indexed: 07/13/2023] Open
Abstract
PURPOSE This study aimed to understand perceptions that knee osteoarthritis patients have regarding their experiences of guideline-based recommendations within their care received from physiotherapists in private practice. METHODS A qualitative semi-structured interview study nested within a larger trial auditing care provided by physiotherapists. Recruited adults ≥ 45 years with knee osteoarthritis across nine primary care physiotherapy practices. Interview questions were anchored around the core elements recommended in guidelines for the management of knee osteoarthritis and patient perceptions of these were analysed using both content and thematic qualitative analysis approaches. Patient satisfaction with care received was asked at the time of interview. RESULTS Twenty-six patients volunteered for the study (mean 60 years, 58% female). Analysis identified that physiotherapists focused on treating symptoms through quadriceps strengthening exercises, which patients found to be effective, though focussed less on other aspects of evidenced-based care. Patient's perceived treatment to be effective in relieving pain and enabling them to stay active and they appreciated the positive role that their physiotherapist provided in alleviating their concerns. Overall, patients were satisfied with their physiotherapy care but would have liked more specific osteoarthritis education and longer-term management. CONCLUSION The description of the physiotherapy-related care received by people with knee osteoarthritis aligns with guideline recommendations, though mainly for strength-related exercise prescription. Despite some perceived shortfalls in care, patients do appear to be satisfied. However, improvements in patient outcomes may be possible if more elements of guideline-base care are regularly provided, including enhancing osteoarthritis education and fostering behaviour change. TRIAL REGISTRATION ACTRN12620000188932.
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Affiliation(s)
- Jeanette M Thom
- School of Health Sciences and Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Faculty of Medicine and Health, UNSW, Sydney, Australia.
| | - Sarah Dennis
- School of Health Sciences and Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, UNSW, Sydney, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Kathryn A Gibson
- Faculty of Medicine and Health, UNSW, Sydney, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Australia
- Rheumatology Department, Liverpool Hospital, Sydney, Australia
- Eli Lilly Australia Pty Ltd., Sydney, Australia
| | | | - Kathryn Mills
- Department of Health Sciences, Macquarie University, Sydney, Australia
| | - Siobhan M Schabrun
- Neuroscience Research Australia, UNSW, Sydney, Australia
- School of Physical Therapy, University of Western Ontario, London, ON, Canada
- The Gray Centre for Mobility and Activity, Parkwood Institute of Rehabilitation, London, ON, Canada
| | - Hans Sun
- Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Justine M Naylor
- Faculty of Medicine and Health, UNSW, Sydney, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Australia
- Whitlam Orthopaedic Research Centre, Orthopaedic Department, Liverpool Hospital, Sydney, Australia
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The use of co-production, co-design and co-creation to mobilise knowledge in the management of health conditions: a systematic review. BMC Health Serv Res 2022; 22:877. [PMID: 35799251 PMCID: PMC9264579 DOI: 10.1186/s12913-022-08079-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background Knowledge mobilisation is a term used in healthcare research to describe the process of generating, sharing and using evidence. ‘Co’approaches, such as co-production, co-design and co-creation, have been proposed as a way of overcoming the knowledge to practice gap. There is a need to understand why researchers choose to adopt these approaches, how they achieve knowledge mobilisation in the management of health conditions, and the extent to which knowledge mobilisation is accomplished. Methods Studies that explicitly used the terms co-production, co-design or co-creation to mobilise knowledge in the management of health conditions were included. Web of Science, EMBASE via OvidSP, MEDLINE via OvidSP and CINHAL via EBSCO databases were searched up to April 2021. Quality assessment was carried out using the Joanna Briggs Institute qualitative quality assessment checklist. Pluye and Hong’s seven steps for mixed studies reviews were followed. Data were synthesised using thematic synthesis. Results Twenty four international studies were included. These were qualitative studies, case studies and study protocols. Key aspects of ‘co’approaches were bringing people together as active and equal partners, valuing all types of knowledge, using creative approaches to understand and solve problems, and using iterative prototyping techniques. Authors articulated mechanisms of action that included developing a shared understanding, identifying and meeting needs, giving everyone a voice and sense of ownership, and creating trust and confidence. They believed these mechanisms could produce interventions that were relevant and acceptable to stakeholders, more useable and more likely to be implemented in healthcare. Varied activities were used to promote these mechanisms such as interviews and creative workshops. There appeared to be a lack of robust evaluation of the interventions produced so little evidence in this review that ‘co’approaches improved the management of health conditions. Conclusion Those using ‘co’approaches believed that they could achieve knowledge mobilisation through a number of mechanisms, but there was no evidence that these led to improved health. The framework of key aspects and mechanisms of ‘co’approaches developed here may help researchers to meet the principles of these approaches. There is a need for robust evaluation to identify whether ‘co’approaches produce improved health outcomes. Trial Registration PROSPERO CRD42020187463. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08079-y.
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Deng R, Zhang H, Huang L, Xiong X, Fu X. MicroRNA-186 ameliorates Knee osteoarthritis via regulation of P2X7-mediated Cathepsin-K/Runx2/ADAMTS5 signalling axis in articular chondrocytes. Saudi J Biol Sci 2021; 28:4270-4275. [PMID: 34354409 PMCID: PMC8324999 DOI: 10.1016/j.sjbs.2021.06.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 11/05/2022] Open
Abstract
Knee osteoarthritis (KOA) is a chronic joint disorder involving the articular cartilage and tissues around the synovial joint. The key objective of this study was to determine the effect of miR-186-5p administration on the expression of pathogenic signalling in the chondrocytes using a surgical destabilization of the medial meniscus (DMM) model of KOA, and to testify the mechanism of P2X7-mediated regulation of RUNX2/ADAMTS5 axis by miR-186 in the KOA rats. After eight weeks of intra-articular injection of the miR-186-5p and negative control lentivirus samples, the knee cartilage tissues were subjected to histopathological analysis Safranin-O/Fast green staining. Further, the articular chondrocytes were separated and analysed for various proteins including P2X7, cathepsin-K, RUNX2 and ADAMTS5 using Western blotting method. We observed that the protein expressions of P2X7, cathepsin-K/RUNX2/ADAMTS5, and also MMP-13 were upmodulated in the KOA rats, while intra-articular miR-186-5p lentivirus administration prevented these aberrations. Hence, the study concludes that miR-186 orchestrates P2X7 expression and the P2X7-mediated cathepsin-K/RUNX2/ADAMTS5 axis and regulates the pathogenesis of KOA. In light of this evidence, we propose that molecular therapeutic interventions targeting miR-186 activation might attenuate osteoarthritic cartilage degeneration.
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Affiliation(s)
- RuLin Deng
- Department of Orthopedics, Nanchang HongDu Hospital of Traditional Chinese Medicine, NanChang, Jiangxi 330006, China
| | - HongJun Zhang
- Department of Orthopedics, Jiangxi provincial People's Hospital Affiliated to Nanchang University, NanChang, Jiangxi 330006, China
| | - Lei Huang
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, NanChang, Jiangxi 330006, China
| | - Xin Xiong
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, NanChang, Jiangxi 330006, China
| | - Xiaoling Fu
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, NanChang, Jiangxi 330006, China
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